400,000 Texas children at risk of losing health insurance

Oct 03, 2017
Nurse practitioner Sherry Fishman Carroll talks to Sasha Rangel, 5, during an examination at People’s Community Clinic on Tuesday. JAY JANNER / AMERICAN-STATESMAN

About 400,000 Texas children and pregnant women could lose health insurance coverage if the federal government doesn’t renew funding for the Children’s Health Insurance Program.

Congress missed the Sept. 30 deadline to reauthorize funding for the program, commonly known as CHIP, leaving some states with enough money for the program to last through the end of the year.

Texas CHIP would run out of money in January or February. After that, the state could face a $3 billion funding hole over the next two years for the program if Congress does nothing, said Carrie Williams, spokeswoman for the Texas Health and Human Services Commission.

“We’ve been watching the CHIP reauthorization issue very closely. Indications are that it will be reauthorized, and we are hopeful for that,” Williams said.

The House and Senate are working on legislation to continue funding the program. Committees in both chambers are expected to consider the bills Wednesday.

Like with any block grant program, Congress must reauthorize funding for CHIP — which covers 9 million children nationally — every few years, but it missed the most recent deadline after failed efforts to repeal and replace the Affordable Care Act, according to advocacy groups.

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“Most of the air has been taken out of the room by the Affordable Care Act repeal and replace effort, so I think that got pushed down the agenda,” said Stacy Wilson, president of the Children’s Hospital Association of Texas. “We are hoping that the bipartisan support that has traditionally underpinned CHIP will continue and that something will get passed.”

Established in 1997, CHIP covers children in families that have incomes above the threshold to be eligible for Medicaid but cannot afford private insurance or obtain employee coverage. In Texas, a family of four with a monthly income of $4,043 or less, or yearly income of $48,513 or less, can qualify for CHIP.

The portion of uninsured Texas children at that income level has dropped from 18 percent in 1998 to 6 percent in 2015, according to the commission.

CHIP covers primary health care, prescriptions, mental health, vision, physical and occupational therapies and dental care for children under 19. Additionally, about Texas 36,000 women receive CHIP coverage for prenatal and postpartum services.

“These are families that are working and their kids are in school,” said Celia Neavel, a physician and director of the Center for Adolescent Health at People’s Community Clinic in Austin. “The cost benefit is huge. If they have chronic illnesses and you want to keep them out of the ER, you want to reduce absenteeism in school, having that ability for the kids to get comprehensive well visits, get routine follow-up, get medication, see specialists as needed, that just makes so much sense.”

People’s clinic sees multiple CHIP patients a day, particularly pregnant women.

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Austin resident Karen Carbajal, 29, said CHIP is a lifeline for her 1-year-old daughter and 10-year-old son, who was getting a physical at People’s on Tuesday.

“We don’t qualify for Medicaid. We both make too much money. I work for a car wash and (my husband) works at an automotive junk yard. CHIP is very important for our kids,” she said.

The bills that Congress is considering would extend the program for another five years but would phase out a 23 percent bump in the federal matching rate over the next few years. That could mean an $800 million loss for Texas in the 2020-21 biennium and possible loss of services.

Currently, the federal government pays for most of the cost of the program.

“The money is significant in just getting that authorized, but you also have to look at how are you paying for it, and if you are paying for it from other vulnerable programs and important health programs, then concern comes up,” said Anne Dunkelberg, associate director for the Center for Public Policy Priorities, an Austin-based liberal think tank.

Diminishing the federal matching rate could affect another 249,000 children in the Texas Medicaid program. Federal Medicaid funding for those children is tied to the higher CHIP rate.

“One in 10 babies born in this country is born in Texas, and so it affects us disproportionately if access to health care is compromised for children,” said Joyce Mauk, a Fort Worth physician and president of the Texas Pediatric Society. “There is nothing good you can say about taking away access to health care for children.”